ICD Codes

ICD10CM:
L98.1 – Factitial dermatitis

ICD9CM:
698.4 – Dermatitis factitia [artefacta]

Synopsis

Factitial dermatitis (dermatitis artefacta) refers to a psychiatric condition in which patients self-induce skin lesions in order to satisfy an unconscious or conscious psychological need to assume the sick role. Patients will not admit to creating the lesions, which are usually more elaborate than simple excoriations. Factitial dermatitis should be differentiated from malingering, in which lesions are created deliberately for secondary gain, such as collecting disability or evading prosecution. Malingering is not a mental illness.

Dermatitis-like lesions, panniculitis, ulcerative disease, and vasculitis-like lesions are all possible. The diagnosis of self-abuse tends to occur more frequently in women and in those working in health care. The psychological profile of the patient with self-induced skin disease is the patient with a dependent and manipulative personality or borderline personality disorder.

The patients' typical lack of concern for how disfiguring their lesions appear is out of proportion to the reality of their presentation. The patient history never seems to add up to explain the unusual cutaneous findings. This so-called "hollow history" is a characteristic of the disease. The lesions may be produced by scratching, picking, biting, cutting, burning, injecting, and puncturing. More serious wounds can be complicated by gangrene, abscess formation, or other life-threatening infections. Treatment is often challenging and multidisciplinary.

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